颈动脉内膜中层厚度与亚临床甲状腺功能减退的Meta分析

A Meta-analysis of carotid intima-media thickness and subclinical hypothyroidism

背景:目前相关研究认为,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,但此观点仍存在许多争议。目的:评价分析亚临床甲状腺功能减退患者的颈动脉内膜中层厚度与甲状腺功能正常者的颈动脉内膜中层厚度是否存在差异。方法:收集已公开发表的有关亚临床甲状腺功能减退患者颈动脉内膜中层厚度与甲状腺功能正常者比较的相关研究,按照Meta分析的要求对检索到的原始文献的研究方法及研究数据进行评价。结果与结论:符合纳入标准的文献8篇,总样本量3 602例。合并结果提示,亚临床甲状腺功能减退组与甲状腺功能正常的对照组的颈动脉内膜中层厚度的差异有显著性意义[加权平均差WMD=0.056,95%CI(0.020,0.092)]。敏感性分析的合并结果采用7项质量更高的研究,进一步证明了亚临床甲状腺功能减退患者的颈动脉内膜中层厚度高于对照组[加权平均差WMD=0.064,95%CI(0.024,0.105)]。亚组分析中,在促甲状腺激素≥10 mU/L的患者,亚临床甲状腺功能减退与颈动脉内膜中层厚度更有显著性关联[加权平均差WMD=0.082,95%CI(0.049,0.116)]。同时,亚临床甲状腺功能减退也与收缩压增高、三酰甘油、总胆固醇、低密度脂蛋白及空腹血糖水平等存在相关性。结果提示,亚临床甲状腺功能减退与颈动脉内膜中层厚度存在相关性,这可能与促甲状腺激素水平的提高、血脂异常、高血压有关。尽管存在明显的个体差异,去进一步评估此观察的结论,大样本量的前瞻性研究是有必要的。

BACKGROUND：Recently, subclinical hypothyroidism has been associated with increased carotid intima-media thickness, but it is controversial. OBJECTIVE：To assess whether carotid intima-media thickness in patients with subclinical hypothyroidism differs from that in euthyroid subjects. METHODS：We searched published studies concerning the carotid intima-media thickness of patients with subclinical hypothyroidism in comparison with euthyroid subjects. Then, we evaluated each potential study for eligibility, assessed the methodological quality, and extracted the data for a Meta-analysis. RESULTS：Eight observational studies with 3602 cases met the eligibility criteria. In patients with subclinical hypothyroidism, the pooled estimate of the weighted mean difference （WMD） of increased carotid intima-media thickness was 0.056 [95%CI （0.020, 0.092）]. Sensitivity analysis using a pooled result of the seven higher-quality studies demonstrated higher carotid intima-media thickness level in patients with subclinical hypothyroidism than in euthyroid subjects [WMD=0.064, 95%CI（0.024, 0.105）]. In a subgroup analysis, subclinical hypothyroidism was even more significantly associated with the carotid intima-media thickness in patients with a mean thyrotropin level 〉 10.0 mU/L [WMD=0.082, 95%CI （0.049, 0.116）]. Subclinical hypothyroidism was also associated with a significant increase in systolic blood pressure, triglyceride levels, total cholesterol levels, low-density lipoprotein levels and with a decrease in fasting plasma glucose. This meta-analysis indicates that subclinical hypothyroidism is associated with an increased carotid carotid intima-media thickness, which may be due to elevated thyrotropin, dyslipidemia and hypertension. Despite the obvious individual differences, a prospective large-sample study is necessary to further assess the conclusions of this observation.